National Variation in Use of Immunosuppression for Kidney Transplantation: A Call for Evidence-Based Regimen Selection

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
David AxelrodKrista L Lentine

Abstract

Immunosuppression management in kidney transplantation has evolved to include an increasingly diverse choice of medications. Although informed by patient and donor characteristics, choice of immunosuppression regimen varies widely across transplant programs. Using a novel database integrating national transplant registry and pharmacy fill records, immunosuppression use at 6-12 and 12-24 mo after transplant was evaluated for 22 453 patients transplanted in 249 U.S. programs in 2005-2010. Use of triple immunosuppression comprising tacrolimus, mycophenolic acid or azathioprine, and steroids varied widely (0-100% of patients per program), as did use of steroid-sparing regimens (0-77%), sirolimus-based regimens (0-100%) and cyclosporine-based regimens (0-78%). Use of triple therapy was more common in highly sensitized patients, women and recipients with dialysis duration >5 years. Sirolimus use appeared to diminish over the study period. Patient and donor characteristics explained only a limited amount of the observed variation in regimen use, whereas center choice explained 30-46% of the use of non-triple-therapy immunosuppression. The majority of patients who received triple-therapy (79%), cyclosporine-based (87.6%) and sirolimus-...Continue Reading

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Citations

Oct 28, 2016·Transplant International : Official Journal of the European Society for Organ Transplantation·Vikas R DharnidharkaKrista L Lentine
Oct 27, 2017·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Lars Pape
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Mar 19, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Chris WiebePeter W Nickerson
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Dec 4, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Julie HoAhmed M Abou-Setta

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